Occupational
Disease in Canada
加拿大职业病管理概况
E. Kevin Kelloway, Ph.D.柯乐威 教授
Canada Research Chair in Occupational Health Psychology
加拿大职业健康心理学研究主席兼圣玛丽大学职业健康与安全中心主任
Overview概况
•OVERVIEW OF CANADA 加拿大概况
•REGULATORY ENVIRONMENT 立法环境
•DEFINITION 定义
•COMPENSATION 赔偿
•TREATMENT 治疗
•PREVENTION 预防
The Land 国土
• 10 million square kilometers - second largest
nation on Earth, after Russia
1000万平方公里—世界上第二大国仅次于俄罗斯
• North to south 4,800 km - more than two thirds of
its residents live within 300 km of its southern
border with 12 states of the United States
南北跨度4800公里--三分之二多的人口居住在和美
国12个州接壤的南部300公里以内的边界地带。
Nunavut
鲁拉乌特地区
Yukon
Northwestern
育空地区 Territories
西北地区
Newfoundland
纽芬兰省
Prince
British
Columbia
Saskatchewan
不列颠哥伦Alberta
Manitoba
萨斯喀彻温省
比亚省 艾尔伯塔省
曼尼托巴省
Quebec
魁北克省
Ontario
安大略省
Edward
Island
New Nova
Brunswic
Scotia
爱德华
k
新斯科
新布拉威克省
王子岛
省
舍省
The People
 The Population 人
persons (thousands)
Canada
国民
口 加拿大人口统计
2002
Thousands 单位千
2003
2004
2005
2006
31,372.60
31,676.10
31,989.50
32,299.50
32,623.50
Newfoundland and Labrador纽芬兰省
519.4
518.4
517.2
514
509.7
Prince Edward Island爱德华王子岛省
136.9
137.3
137.9
138.2
138.5
Nova Scotia新斯科舍省
934.5
936.5
938
936.1
934.4
New Brunswick新布拉威克省
750.3
751.2
752.1
751.5
749.2
Quebec魁北克省
7,445.70
7,494.70
7,548.60
7,597.80
7,651.50
Ontario安大略省
12,102.00
12,262.60
12,416.70
12,558.70
12,687.00
1,155.60
1,161.90
1,170.50
1,174.10
1,177.80
995.9
994.7
994.9
990
985.4
Alberta艾尔伯塔
3,116.30
3,161.40
3,207.00
3,277.60
3,375.80
British Columbia卑诗省
4,115.40
4,155.40
4,203.30
4,257.80
4,310.50
Yukon Territory育空地区
30.1
30.6
30.9
31.1
31.2
Northwest Territories西北地区
41.5
42.2
42.8
42.6
41.9
Nunavut鲁拉乌特地区
28.7
29.2
29.6
30
30.8
Manitoba曼尼托巴省
Saskatchewan萨斯喀彻温省
Note: Population as of July 1. 2006
The People
国民
• Canada’s Population is over 31.6 million people.
人口超过3160万
• 1.17 million people (4%) are Aboriginal Peoples:
– First Nations (60%), Métis (33%), Inuit (4%) and Other (3%)
117万（4%）为土著居民：-原住民（60%），米提人（法裔
土著混血33%），因纽特人（4%）
• 6.2 million people (20%) are Immigrants.
620万（占人口20%）移民
• Canada’s population growth (1997-2005) is attributable to:
加拿大的人口增长（1997-2005）主要来自于：
– 3 million births, 2 million deaths and over 2 million new
immigrants.
出生人数300万，死亡人数200万，超过200万的新移民
• Most Canadians live in urban settings - over 80% reside in
towns and cities.大部分加拿大人居住在城市环境-80%的人居住
在城镇和城市中
The Canadian Constitution加拿大宪法
• Canada is a federation with three levels of government:
federal, provincial and municipal加拿大是由三级政府组
成的联邦体制：联邦、省、市
• Under the Canadian Constitution, powers are divided
between the federal and provincial governments
根据加拿大宪法，联邦和省级政府分权
• Municipalities are not recognized in the Constitution
except to the extent that they are the responsibility of
provinces 宪法中对市级政府的管理范围没有明确，只提
到该级政府由省级政府负责
• There are about 4,000 municipal governments in
Canada加拿大大约有4000个市政府
8
The Canadian Constitution 加拿大宪法
• The federal government maintains the “peace, order and good
government” of the whole country by making laws with respect to
immigration, unemployment insurance, trade and commerce,
national defence, native affairs, and criminal law. 联邦政府通过制定
关于移民、失业保险、商贸、国防、少数民族事务和刑法等法律，来
维持整个国家的“和平、秩序和良政”。
• Provincial governments are empowered to control regional and local
affairs including education, health, social services, property rights,
administration of justice, local public works, and municipal
institutions. 省级政府被授权管理地区和地方事务，包括：教育、卫
生、社会服务、财产权、司法管理、地方公共设施和市级机构。
• Some responsibilities are shared between the federal and provincial
governments such as immigration, agriculture, and pensions. 在有些
领域中，联邦和省政府共同承担责任，如移民、农业和养老金。
• Municipal governments - strictly local matters市政府-仅限于管理当
地事务
9
Economy
•
•
加拿大的经济
the eight - largest trading nation • Natural Resources :
– Iron Ore
世界第八大贸易国
high-tech industrial society,
Canada today closely
• resembles the US 当今的加拿
大是高新技术工业社会，和美国
十分相似
• advantages - natural resources,
skilled labor force, and modern
capital plant
• 经济优势：自然资源、高技能的
劳工队伍和现代化的工厂
–
–
–
–
–
–
–
–
–
–
–
–
–
–
Nickel
Zinc
Copper
Gold
Lead
Potash
Silver
Fish
Timber
Wildlife
Coal
Petroleum
Natural Gas
Hydropower
Economy
GDP
经济
1,062,951
1,183,900
957,258
1,200,000
816,756
1,000,000
800,000
600,000
GDP
400,000
200,000
0
1997
2001
2005
2009
The workforce 劳动力结构
Industry 行业
Number 人数
Goods Producing 商品生产
3,708,300
Agriculture 农业
321,900
Natural Resources 自然资源
310,700
Utilities 基础设施
149,900
Construction 建筑
1,178,000
Manufacturing 制造业
1,756,800
The workforce劳动力结构
Industry
行业
Number 人数
Industry 行业
Number
人数
Services 服务业
13,086,400
Trade 贸易
2,632,100
Accommodation/
Food 酒店/食品
1,034,500
Transportation and
warehousing 交通和仓储
819,900
Other 其他
785,500
Finance, insurance, real
estate金融、保险和房地产
1,118,000
Public Admin
公共管理
923,800
Professional专业技术人员
1,196,900
Business services商业服务
639,000
Education教育
1,196,500
Health Care Social Services
公共卫生服务
1,955,100
Occupational Injuries/diseases
职业伤害/职业病
Total Claims
Number of
Workers Covered Reported
(000s) (1)
Accepted Time-Loss Injuries
Total
Fatalities
% Time-Loss
Injuries
涉及到工人
统计的申报
受理的误工 误工工伤比
数字
工伤
率
Total
1996
10 758.6
947 776
377 885
39.9
703
0.07
1997
10 986.7
962 134
379 851
39.5
833
0.09
1998
11 259.4
970 224
375 360
38.7
798
0.08
1999
11 548.4
996 617
379 450
38.1
835
0.08
2000
11 781.8
1 050 226
392 502
37.4
882
0.08
2001
11 983.9
1 021 524
373 216
36.5
919
0.09
2002
12 148.8
997 691
359 174
36.0
934
0.09
2003
12 729.0
980 436
348 715
35.6
963
0.10
2004
12 708.2
977 118
340 502
34.8
928
0.09
2005
13 052.2
994 886
337 930
34.0
1 097
0.11
Average
11 895.7
989 863
366 459
37.0
889
0.09
r
死亡数
% Fatalities
死亡率
The Accident Pyramid
事故金字塔结构
For every one workplace death there are
34 injuries resulting in lost time,
900 minor injuries,
1,500 near misses,
and 20,000 unsafe actions.
作业点每死亡1人的同时大约有
34人受伤误工
900人受轻伤
1500人侥幸脱险
和20,000人次违法安全规定操作
Cause of workplace fatality
作业点死亡原因统计 (2005)
•
•
•
•
•
•
•
•
Exposure to harmful substances or environments – 512 deaths
(asbestos is the single leading cause)接触有害物质或环境-512人（石棉
是最主要的原因）
Transportation accidents – 229 deaths交通事故-229人
Contact with objects and equipment – 142 deaths
接触物体及操作设备致死-142人
Falls – 77 deaths高坠或摔倒-77人
Bodily reaction and exertion – 30 deaths
身体反应及用力不当-30人
Fire or explosion – 19 deaths火灾或爆炸-19人
Assaults and violent acts – 21 deaths 施暴和其它攻击性暴力行为-21人
Other (events or exposures, unknown or simply not specified) – 67
deaths其他（事故或接触 ，情况不明或不具体）-67人死亡
Regulatory Environment 立法环境
HEALTH CARE医疗卫生
•Canada has 1 Federal and 13 provincial and territorial governments
加拿大有1个联邦政府和13个省级和特区政府
•Constitution says that [a] health care is a provincial/territorial
responsibility and that [b] all Canadians have access to the same level of
health care no matter where they live
宪法规定，医疗卫生由省级或特区政府管理，无论居住在哪个地方，
所有加拿大人都享有同样水平的医疗卫生服务
•Role of the Federal government is to provide funding, ensure equality and
ensure compliance with the Canada Health Care Act
联邦政府的职责是提供资金，确保平等并且加拿大医疗保健（卫生）
法得到执行
Regulatory Environment立法环境
Occupational Health and Safety 职业卫生与安全
•Regulated mostly at the provincial level (over 80% of workers)
主要由省政府立法（涵盖超过80%的工人）
•Workers in some industries (e.g., banking, inter-provincial transportation) are
federally regulated有些行业（如银行、省际交通）则属于联邦立法范围
• Great deal of collaboration between provincial and federal agencies – so
regulations are very similar (but not exactly the same) across jurisdictions省级
和联邦机构之间进行了大量协作-所以各个管辖区的法规非常相似（但是
并不完全相同）
Definition of Occupational
Disease职业病的定义
•Two main elements are present in the definition of an occupational disease: 职
业病的定义包括两个要素
• the causal relationship between exposure in a specific working environment
or work activity and a specific disease; and 某一疾病与接触某一工作环境或
从事某一工作存在的因果关系
• the fact that the disease occurs among a group of exposed persons with a
frequency above the average morbidity of the rest of the population. 接触特定
环境工作的人群患某一疾病频率高于其他人群
Classes of Occupational
Disease (ILO)职业病的分类
1. Diseases caused by agents由不同因素导致的职业病
1.1 Diseases caused by chemical agents
化学因素导致的职业病
1.2 Diseases caused by physical agents
物理因素导致的职业病
1.3 Diseases caused by biological agents
生物因素导致的职业病
2. Diseases by target organ特定器官疾病
2.1 Occupational respiratory diseases职业呼吸道疾病
2.2 Occupational skin diseases职业皮肤病
2.3 Occupational musculoskeletal diseases职业骨骼疾病
3. Occupational cancer职业性癌症
4. Others其它
Some problematic
characteristics存在的一些问题
• Results from cumulative (chronic) rather than acute
exposure
结果来自长期积累（慢性）而非急性接触
• Delayed onset conditions推迟了发作因素
• Not unique to occupational exposures 有些职业病不
仅限于职业接触引起
Compensation赔偿
• Applied for (typically) after diagnosis
诊断后申请
• Application likely to be successful if [a] employed in a known
high risk occupation for specific condition; [b] documented
exposure to hazard; and [c] clinical diagnosis/impairment
如具备以下条件申请可能成功：1.受雇于高危行业；2.有接触致
危因素的条件；3.医疗诊断/损伤
• Most WCBs recognize presumptive cases (firefighters and some
cancers, coal miners and silicosis, construction workers and
HAVS)
大多数工伤赔偿局接受以下推理的情况为职业病（消防员与一些
癌症，煤矿工人与矽肺病，建筑工人与手臂振动综合症
• Can extend into retirement
赔偿可以延续到退休以后
Treatment治疗
• Occurs in the regular health care system在正规医疗卫生系统进行
• Not tied to compensation but if pensionable, then award may include
medical costs (e.g., drugs) not normally paid for in health care system与赔
偿无关，如果可以领养老金，赔偿则会包括医疗卫生系统通常不会支
付的医疗费用（如某些药品）
• Some specific occupational clinics in larger centres (e.g., occupational
medicine, HAVS etc), by referral, additional costs paid for by insurer大中
心的一些特定职业诊所（如职业药物、手臂振动综合症等）的转诊病
人，额外费用由保险公司支付
• Some specialized clinics (e.g., pain clinics) – by referral, additional costs
paid by insurer一些特定门诊（如疼痛门诊）的转诊病人，额外费用由
保险公司支付
• Insurer may institute active return to work policies including treatment, job
accomodation, ergonomic redesign etc保险公司会遵守相关规定，包括
治疗、重新安排工作、根据人体工学重新设计等。
Prevention预防
• Dealt with under the OHS legislation – no distinction
made between occupational accidents and
occupational disease针对职业卫生与安全立法-没有将
职业事故和职业病加以区别
• Since all occupational disease results from exposure
to a hazard, prevention focuses on controlling the
exposure:因所有职业病都由接触致危因素导致，预防
的重点主要为控制接触
• At the source – elimination, engineering and administrative
controls源头上-消除、工程和管理控制
• Along the path – elimination, engineering and administrative
controls过程中- 消除、工程和管理控制
• At the worker – personal protective equipment (PPE)工人-个
人防护用品
Types of control控制类型
Engineering Controls工程控制 -MOST EFFECTIVE最有效
Process control – change how job is done
过程控制-改变工作方式
Isolation/enclosure of emission source隔离/关闭排放源
Ventilation通风
Administrative Controls 管理控制–CAN BE UNRELIABLE可能靠不住
Scheduling/job rotation/rest periods日程安排/工作轮换/休息时间
Work Practices工作实践
Emergency preparedness应急准备
Personal Hygiene个人卫生
Personal Protective Equipment (PPE) - CAN FAIL
WITHOUT
WARNING
个人防护用品-如果无警告可能无效
Public Health in Canada 加拿大的公共卫生
The role of the Public Health Agency of Canada is to:
* Promote health;
* Prevent and control chronic diseases and injuries;
* Prevent and control infectious diseases;
* Prepare for and respond to public health emergencies, and
* Strengthen public health capacity in a manner
consistent with a shared understanding of the
determinants of health and of the common factors that
maintain health or lead to disease and injury.
NO SPECIFIC ROLE IN OCCUPATIONAL HEALTH AND SAFETY
加拿大的公共卫生机构的职责是：
促进健康；
预防和控制慢性病和伤害；
预防和控制传染病；
公共卫生紧急事件应急准备和处理；
注重决定卫生的因素，增强对医疗保健，常见致病及工伤因素
的认识，以此加强加拿大的公共卫生能力；
政府并没有赋予卫生部门专门的职业卫生与安全的特别职能。
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THANK YOU!!!!